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2014-2015 SPECIAL CONDITIONS
RETURN TO:
CAL POLY
FINANCIAL AID OFFICE
SAN LUIS OBISPO, CA 93407-0201
FAX: (805) 756-7243
Student Last Name:
Student First Name:
Phone #
EMPL ID#:
financialaid@calpoly.edu
DEADLINE: All forms should be submitted as soon as possible. In all circumstances documents must be submitted prior to the last day
of a student’s enrollment for any aid.
Consideration of special conditions requires verification of your FAFSA data. If it is determined the
submitted information may positively impact your current award, you will be notified regarding any
other documents and forms
that may be required to finalize the review.
For Office Use Only
SPECIAL CONDITIONS:
If you or your family have unusual circumstances that might affect your financial aid eligibility, please mark
the appropriate box or explain below:
Initials _________
Excessive medical/dental expenses not covered by insurance
Attach supporting documentation: Medical/dental receipts
Parent in college: My parent(s) attends college at least half-time and is pursuing a degree during 2014-2015
Attach supporting documentation: Parent’s enrollment & degree/certificate program verification.
Student’s child care costs
Attach supporting documentation: Child care receipts
Marriage (student): I have updated my FAFSA to reflect a change in marital status
Attach supporting documentation: Marriage certificate and student statement addressing change in ability to pay for school
Death of parent or spouse
Attach copy of death certificate and information on surviving parent or student (if spouse) income and assets.
IRA/Pension Rollover
Attach supporting documentation: 1099R and Tax Return Transcript
Other:
Attach supporting documentation.
SIGNATURES ARE REQUIRED FOR ALL PERSONS REPORTING SPECIAL CONDITIONS ON THIS FORM: For example, parent
signature required when submitting parent medical or tuition expenses.
I/we certify that all the information reported on this form and any attachment is true, complete and accurate.
False statements or misrepresentation will be cause for denial, reduction, withdrawal, and/or repayment of financial aid.
_________________________________________________
Student Signature (no electronic signatures)
Date
____________________________________________
Parent Signature (no electronic signatures)
Date
FSPC15